Health Care and Immigration: Uncomfortable Bedfellows

Gutierrez, who has led the Congressional Hispanic Caucus’ immigration efforts, has said the two parties don’t see eye to eye on who should have access to health care.

The Congressional Hispanic Caucus was emphatic that illegal immigrants should be included when the landmark health care bill was being negotiated in 2009. But the White House and Democratic leaders said it was not the right time and health care would be taken care of when immigration was overhauled.

Now, as both chambers get serious about approving legislation that could enable about 11 million illegal immigrants to become citizens, Hispanic lawmakers are again being told that now is not the time. Barring a dramatic change of course, neither the bipartisan Senate bill nor a bipartisan House measure that’s now being crafted would help millions of uninsured, illegal immigrants get health insurance.

Any debate on health and immigration brings together one of the most polarizing laws in the country’s history — the Affordable Care Act (PL 111-148, PL 111-152) — with the equally emotional and divisive issue of immigration. It’s a toxic combination.

“Even when we are not discussing immigrants, Republicans and Democrats do not see eye to eye on who should have access to health care and under what circumstances,” said Rep. Luis V. Gutierrez, the Illinois Democrat who planned to retire but stayed in Congress to push for an immigration overhaul. Gutierrez, who has led the Congressional Hispanic Caucus’ immigration efforts, does not appear prepared to risk the effort with a wholesale debate over immigration and health care.

“The partisan politics of health care almost fatally infected the bipartisan policy cooperation on immigration,” he said in an email. So the bipartisan House group, of which he is a member, has decided to follow the Senate’s lead.

Under the Senate bill (S 744), illegal immigrants could buy insurance in the new health care marketplaces. But unlike American citizens and legal permanent residents, those with “registered provisional immigrant” status would not be eligible for the law’s federal tax credits to help them afford insurance on the exchanges. And these provisional immigrants would not be subject to the law’s mandate to have health insurance.

Gutierrez knows there is more to this debate. “The reality is that on a five-, 10- or 15-year path to citizenship, someone — or someone in your family — is likely to get sick or injured,’’ he said. “The question is whether Congress makes getting sick or injured and incurring health care costs a condition for staying in the country legally, and I think we should not.”